The impact of plasma 25-hydroxyvitamin D on pulmonary function and exercise physiology in cystic fibrosis: A multicentre retrospective study

Raquel Revuelta Iniesta; Adam J Causer; Irantzu Arregui-Fresneda; Gary Connett; Mark I Allenby; Thomas Daniels; Mary P Carroll; Don S Urquhart; Zoe L Saynor

doi:10.1111/jhn.12906

The impact of plasma 25-hydroxyvitamin D on pulmonary function and exercise physiology in cystic fibrosis: A multicentre retrospective study

J Hum Nutr Diet. 2022 Apr;35(2):363-375. doi: 10.1111/jhn.12906. Epub 2021 Jun 1.

Authors

Raquel Revuelta Iniesta^{1

2}, Adam J Causer^{3

4}, Irantzu Arregui-Fresneda⁴, Gary Connett⁵, Mark I Allenby⁴, Thomas Daniels⁴, Mary P Carroll⁴, Don S Urquhart⁶, Zoe L Saynor^{4

7}

Affiliations

¹ School of Sport and Health Sciences, University of Exeter, Exeter, UK.
² Child Life and Health, University of Edinburgh, Edinburgh, UK.
³ Department for Health, University of Bath, Bath, UK.
⁴ Wessex Cystic Fibrosis Unit, University Hospital Southampton Foundation NHS Trust, Southampton, UK.
⁵ National Institute for Health Research, Southampton Biomedical Research Centre, Southampton Children's Hospital, Southampton, UK.
⁶ Department of Paediatric Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, UK.
⁷ School of Sport, Health and Exercise Sciences, University of Portsmouth, Portsmouth, UK.

PMID: 33908093
DOI: 10.1111/jhn.12906

Abstract

Background: A 25-hydroxyvitamin D (25OHD) may exert immunomodulatory effects on respiratory health, which may translate to improvements in exercise physiology. Thus, we aimed to investigate whether plasma 25OHD is associated with lung function and aerobic fitness in people with cystic fibrosis (pwCF).

Methods: A multicentre retrospective review of pwCF (> 9 years old) attending the Royal Hospital for Sick Children (Edinburgh) or Wessex CF-Unit (Southampton) was performed between July 2017 and October 2019. Demographic and clinical data were collected. Plasma 25OHD measured closest in time to clinical cardiopulmonary exercise testing and/or spirometry [forced expiratory volume (FEV₁ )% predicted] was recorded. Pancreatic insufficiency was diagnosed based on faecal elastase of < 100 µg g^-1 . We performed multiple-regression analysis with aerobic fitness outcomes [peak oxygen uptake (VO_{2 peak} )] and FEV₁ % predicted as primary outcomes.

Results: Ninety pwCF [mean ± SD age: 19.1 ± 8.6 years, 54 (60%) children, 48 (53%) males and 88 (98%) Caucasian] were included. 25OHD deficiency and insufficiency was 15 (17%) and 44 (49%), respectively. 25OHD deficiency and insufficiency was significantly associated with pancreatic insufficiency (χ² = 4.8, p = 0.02). Plasma 25OHD was not significantly associated with FEV₁ % predicted (r² = 0.06, p = 0.42, 95% CI = -0.09 to 0.19) or VO_{2 peak} (r² = 0.04, p = 0.07, 95% CI = -011 to 0.005) in all pwCF. However, 25OHD was significantly associated with both FEV₁ % (r² = 0.15, p = 0.02, 95% CI = 1.99-2.64) and VO_{2 peak} (r² = 0.13, p = 0.05, 95% CI = -0.26 to -0.005) in the paediatric cohort.

Conclusions: We showed that 25OHD is associated with improved lung function and aerobic fitness in children and adolescents with CF. Mechanistic and high-quality prospective studies including both lung function and aerobic fitness as primary outcomes are now warranted.

Keywords: cardiopulmonary exercise testing; cystic fibrosis; lung function; ventilation; vitamin D.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Child
Cystic Fibrosis* / complications
Exocrine Pancreatic Insufficiency*
Female
Humans
Lung
Male
Prospective Studies
Retrospective Studies
Vitamin D / analogs & derivatives
Young Adult

Substances

Vitamin D
25-hydroxyvitamin D